TY - JOUR
T1 - Impact of inadequate initial antimicrobial therapy on mortality in patients with bacteraemic cholangitis
T2 - a retrospective cohort study
AU - Tagashira, Y.
AU - Sakamoto, N.
AU - Isogai, T.
AU - Hikone, M.
AU - Kosaka, A.
AU - Chino, R.
AU - Higuchi, M.
AU - Uehara, Y.
AU - Honda, H.
N1 - Publisher Copyright:
© 2017 European Society of Clinical Microbiology and Infectious Diseases
PY - 2017/10
Y1 - 2017/10
N2 - Objectives Acute cholangitis is a common cause of bacteraemia resulting in severe sepsis or septic shock. The impact of the appropriate initial antimicrobial therapy on short-term mortality in bacteraemic cholangitis has not been well investigated. Methods We conducted a retrospective cohort study of patients with bacteraemic cholangitis at two large tertiary care centres in Tokyo, Japan between 2009 and 2015. We determined the factors associated with 30-day all-cause mortality from the date of drawing the first positive blood culture, using a multivariate logistic regression analysis. Results We identified 573 patients with bacteraemic cholangitis (median age, 77 years; male, 58.3%). The 30-day all-cause mortality rate was 6.6% (38/573). Inadequate initial antimicrobial therapy occurred in 133 (23.2%) patients. Factors associated with 30-day all-cause mortality included the Charlson co-morbidity index score >3 (adjusted odds ratio (aOR) 4.12; 95% CI 1.18–14.38), jaundice (total bilirubin >2.5 mg/dL) (aOR 3.39; 95% CI 1.46–7.89), septic shock within 48 h of the first positive blood culture (aOR 3.34; 95% CI 1.42–7.89), biliary obstruction due to hepatobiliary malignancy (aOR 8.00; 95% CI 2.92–21.97), and inadequate initial antimicrobial therapy (aOR 2.78; 95% CI 1.27–6.11). Conclusions Inadequate initial antimicrobial therapy was an important, modifiable determinant of survival.
AB - Objectives Acute cholangitis is a common cause of bacteraemia resulting in severe sepsis or septic shock. The impact of the appropriate initial antimicrobial therapy on short-term mortality in bacteraemic cholangitis has not been well investigated. Methods We conducted a retrospective cohort study of patients with bacteraemic cholangitis at two large tertiary care centres in Tokyo, Japan between 2009 and 2015. We determined the factors associated with 30-day all-cause mortality from the date of drawing the first positive blood culture, using a multivariate logistic regression analysis. Results We identified 573 patients with bacteraemic cholangitis (median age, 77 years; male, 58.3%). The 30-day all-cause mortality rate was 6.6% (38/573). Inadequate initial antimicrobial therapy occurred in 133 (23.2%) patients. Factors associated with 30-day all-cause mortality included the Charlson co-morbidity index score >3 (adjusted odds ratio (aOR) 4.12; 95% CI 1.18–14.38), jaundice (total bilirubin >2.5 mg/dL) (aOR 3.39; 95% CI 1.46–7.89), septic shock within 48 h of the first positive blood culture (aOR 3.34; 95% CI 1.42–7.89), biliary obstruction due to hepatobiliary malignancy (aOR 8.00; 95% CI 2.92–21.97), and inadequate initial antimicrobial therapy (aOR 2.78; 95% CI 1.27–6.11). Conclusions Inadequate initial antimicrobial therapy was an important, modifiable determinant of survival.
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U2 - 10.1016/j.cmi.2017.02.027
DO - 10.1016/j.cmi.2017.02.027
M3 - Article
C2 - 28254686
AN - SCOPUS:85018184351
SN - 1198-743X
VL - 23
SP - 740
EP - 747
JO - Clinical Microbiology and Infection
JF - Clinical Microbiology and Infection
IS - 10
ER -